Rutland Regional Medical Center in Rutland, Vermont is a rural site participating in the New England Innovations in Asthma Collaborative (NEIAC). The project is integrated with the Rutland Community Health Team and Community Health Improvement operations, providing resources and wrap-around support for patients with chronic conditions, in concert with the Vermont Blueprint for Health initiative. Our purpose is to improve care for patients with chronic conditions and promote self-management, working with primary care providers, and health and human services organizations to coordinate and collaborate for system change.

The In-home Pediatric Asthma Program was a natural fit, and we adopted the approach to serve our community. Home visits provide asthma education for the child and family, tailored to their needs, identifying triggers (allergens and irritants) and methods to reduce them while sharing information about ways to identify and decrease asthma symptoms. We accept referrals from any source, including self-referrals from families.

We have been very active reaching out to providers, school nurses, RRMC’s emergency department, our local Medicaid office, and other potential referral sources, to inform them of the existence of the program, the eligibility criteria and the anticipated benefits. Approximately six months into the implementation, we returned to the primary pediatric facility in the region and presented on the program to staff and providers, sharing success stories of our work with their own patients. This helped to reinforce the importance of the program for children and families with asthma.

Since January 2013, we have served 33 families, and expect to provide in-home service to 25 more families before the end of June. The successes are our motivation, so we share the comments from a recent parent:

“I would like to thank everyone involved. It’s such a wonderful program. I wish I had done it sooner. Everyone is so smart and understanding. I was at ease with the visits. Everyone was so kind and helpful. You have opened my eyes and changed and impacted our lives forever. Thank you so much. I am eternally grateful.”